Friday, June 22, 2007

Assited Reproduction: Twins--and More!

See the following article, Fertility Treatments Bring Twins—and Trouble, based on a book on infertility treatments, Everything Conceivable: How Assisted Reproduction Is Changing Men, Women, and the World that appears to be relevant and well-researched. As a woman who used assisted reproduction and third-party reproduction to conceive my children, I am always appreciative of balanced reporting and literature and the following article and book appear to have achieved those goals.

Fertility Treatments Bring Twins—and Trouble
by Joanne McNeil
These days, everyone has twins. Julia Roberts has twins. Holly Hunter, Patrick Dempsey, Lance Armstrong, Cheryl Tiegs, Joan Lunden—and don't forget the President and First Lady. Since 1980, the number of twins has climbed 75%, from 70,000 to close to 130,000 in 2003. Women over 35 are likely to have a multiple birth at a rate of 1 in 18. With in vitro fertilization (IVF) births, the rate of multiple deliveries is 1 in 3. That means more than half of all IVF babies are born in a "set."

But Liza Mundy, Washington Post reporter and author of Everything Conceivable, shows that these multiple births come with a risk. The likelihood of cerebral palsy, developmental delay, and other brain and nerve disorders increases. The infant mortality rates of twins are four to five times that of single births, and for triplets the rate is higher still.

Mundy's book steers a clear path through many of IVF's complicated implications. She provides a thorough history of IVF’s scientific progress, along with engrossing anecdotal narratives and commentary on ethical dilemmas.

Mundy's book steers a clear path through many of IVF's complicated implications.

Women that use IVF are often characterized as selfish, career-driven, and shortsighted: If they wanted so badly to be mothers, couldn't they have done it at the age of 25? Mundy quickly dispels this stereotype, reminding us that while feminists might have secured a place for women in the workforce in the 1980s, few policies back then allowed for a family/work balance. Maternity leave was unheard of, and workdays were not flexible. "Women responded by not taking maternity leave and by not asking for flexible workdays. They responded—to a complex set of incentives, including the fact that their partners and husbands were really liking this extra paycheck thing, this high-earning spouse, this chance to endlessly dine out and travel—by not having children, yet.”

And there are other reasons for couples to delay having families. Richard Paulson, chief at the fertility clinic at the University of Southern California, gave Mundy a hypothetical example of an infertile woman born in 1943, "[In] 1983 when she was forty, IVF technology was starting to percolate into clinics in the States, but they were only taking women under forty. In 1988, she was 45 and her eggs were not going to work. Then she turns fifty and the technology of egg donation was now available. She finds that technology has finally caught up with her, and at the age of fifty, she can go in and have a baby.”

Data show adoptive parents are as loving—in some research even more loving—of their children as biological parents, but technology is further blurring that binary distinction. If a woman conceives a child, produced from the egg of a donor and her husband’s sperm, is she any less of a “biological” parent than her husband?

Still, the use of donor eggs remains the ultimate IVF taboo. Not a single celebrity, 40-something new mom has confessed to using a donor, although at that age it is almost impossible to conceive with one's own eggs. When Slate magazine speculated that Elizabeth Edwards, wife of John Edwards, used a donor to conceive her twins (she was 48 at their birth, he was 50), she admitted to "shots," but said that disclosing any more would not be "ladylike."

Mundy's account of the dilemmas posed by unused frozen embryos is the most compelling. She interviewed one couple that pays $2,000 a year to two separate clinics to keep their unused embryos stored in liquid nitrogen. "The range of choices is dizzying: Should they donate these excess embryos to another couple to gestate and bear? Their own daughters' full biological siblings, raised in a different family? Should they donate the excess embryos to scientific research? Or should they authorize both clinics to remove the glass straws containing the embryos from the liquid nitrogen? Knowing how difficult pregnancy is for her?"

As one doctor tells her, “Even cancer patients aren’t as motivated as fertility patients.”

Fertility clinics often suffer the consequences of deadbeat IVF patients. They hire collection agencies to get former patients to make an executive decision, but if the clients can’t be found, the clinics are stuck. One fertility clinic chief told Mundy he fears what will happen when he retires. “The person buying [the clinic] does not want to inherit embryos. That’s the rule. People do not want to inherit embryos. So what do you do with them? I have embryos that have been here since 1992.”

Not without controversy, fertility clinics in Great Britain are ordered to destroy unused embryos after five years. In reality, IVF technology is so new that we don’t even know if there is a natural expiration date. Mundy reports a San Francisco couple gave birth to child who, as an embryo, was frozen for thirteen years.

While one might not sway with some of the regulatory proposals Mundy subtly hints at, her book is nevertheless illuminating, exhaustingly researched, and, most importantly, sympathetic. Assisted reproduction has helped couples achieve their dreams of parenthood, but it has also further broken the spirits of others. As one doctor tells her, “Even cancer patients aren’t as motivated as fertility patients.” Thanks to this book, many of these would-be patients will not proceed on their quest to have children quite so blindly.

Joanne McNeil is science and technology editor of Brainwash. She is also a frequent contributor to Bookslut and The Washington Times.